Emergency Devices

7/27/2019 Emergency Devices

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Scoop stretcher

A scoop stretcher. Note that the stretcher is upside down: the narrow end of the stretcher is for the patient's legs and feet.

The scoop stretcher (or clamshell, Roberson orthopedic stretcher, or justscoop) is a device used specifically forcasualty lifting. It ismost frequently used to liftsupinepatients from the ground, either due to unconsciousness or in order to maintain stability in the

case of trauma, especiallyspinal injury, where it is used as an intermediate step between the ground and a restraining device suchas along spine boardorvacuum mattress.

A scoop stretcher has a structure that can be split vertically into two parts, with shaped 'blades' towards the centre which can be

brought together underneath a patient. The two halves are placed separately either side of the patient, and then brought together until

securing clips at the top and bottom both engage.
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Top: putting the scoop stretcher; middle: casualty lifting with five team members (one is pushing the normal stretcher); bottom: view

from below)

Scoop stretchers reduce the chance of undesirable movement of injured areas during transfer of a trauma patient, as they

maintain the patient in a supine alignment during transfer to astretcher,vacuum mattressorlong spine board).

The scoop stretcher can be used forpatient transport, provided the patient is strapped. But for comfort reasons, it is

recommended to transfer the patient to avacuum mattressorlong spine boardinstead, the scoop stretcher is put on the transport

device and then opened.

The scoop stretcher is part of the origin of the term "stoop and scoop", or "stay and play". "Stoop and scoop" suggests a scenario

in which prompt transport to ahospitalis demanded, while a situation in which there is time to provide care on scene may be

considered a "stay and play" scenario.

Long spine board.
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Spine immobilization with a long spine board

A spinal board, also known as a long spine board (LSB), longboard, spineboard, or backboard,is apatienthandling device usedprimarily in pre-hospitaltraumacare designed to provide rigid support during movement of a patient with suspected spinal or limb

injuries.[3]They are most commonly used byambulanceservices, by staff such asemergency medical techniciansandparamedics, but

are also used by specialist emergency personnel such as lifeguards.

Indications for use

A spinal board is primarily indicated for use in cases of trauma where the medical or rescue personnel believe that there is a

possibility ofspinal injury, usually due to mechanism of injury, and the attending team are not able torule out a spinal injury.

Due to the problems associated with extended use, it is designed primarily as anextricationdevice, especially from vehicles.

Backboards are almost always used in conjunction with the following devices:

acervical collarwith occipital padding as needed;

side head supports, such as a rolled blanket or head blocks made specifically for this purpose, used to avoid the lateral rotationof the head;

straps to secure the patient to the long spine board, and tape to secure the head

Construction

Spine boards are typically made of wood or plastic, although there has been a strong shift away from wood boards due to theirhigher level of maintenance required to keep them in operable condition and to protect them from cracks and other imperfections

that could harbour bacteria.

Backboards are designed to be slightly wider and longer than the average human body to accommodate the immobilization

straps, and have handles for carrying the patient. Most backboards are designed to be completelyX-raytranslucent so that they do
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not interfere with the exam while patients are strapped to them. They are light enough to be easily carried by one person, and are

usually buoyant.

Clinical issues

Common clinical issues found with spinal boards includepressure soredevelopment, inadequacy of spinal immobilization,pain and discomfort, respiratory compromise and affects on the quality of radiological imaging. For this reason, some

professionals view them as unsuitable for the task, preferring alternatives.

It is advised that no patient should spend more than 30 minutes on a spine board, due to the development of discomfort and

pressure sores.

Alternatives

The primary alternative, now considered gold standard for trauma care, is thevacuum mattress, which is flexible when soft, but it

hardened through evacuation of air. The conforming nature of the vacuum mattress means that patients can be kept immobilised onit for longer periods of time and the immobilisation offers superior stability and comfort to the patient.

There are also short spine boards, but the short spine board is rarely used now due to the presence of superior devices, such as

theKendrick Extrication Device.

FIELD USE OF THE

LONG SPINE BOARD

APPLICATION1. FirstOfficerundertakes a full assessment of the patient before application of the Long

Spine Board. This includes:

Check safety, scene, and situation.
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A Second Officerbrings c-spine into neutral in-line position (unless contra-indicated)and performs manual head stabilisation.

Perform Primary Survey:

i. Responseii. Airwayiii. Breathingiv. Circulation (Pulse & Major Bleeds)

Perform Basic Care:i. Restii Reassureiii. Oxygeniv. Positionv. Pulse Oximeter

Perform A Vital Signs Survey:i. Conscious Status Assessmentii. Perfusion Status Assessmentiii. Respiratory Status Assessment

Perform A Secondary Survey:i. Motor/Sensory x 4ii. Head

iii. Spineiv. Chestv. Abdomenvi. Pelvisvii. Legsviii. Arms

Check AMPLE:

i. Allergiesii. Medicationsiii. Past Medical Historyiv. Last Oral Intakev. Events Leading Up To Injury

Apply:i. Cervical Collarii. Cervical Extrication Device (if indicated)


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iii. Long Spine Board using procedures provided in this manualiv. Immobilise patient

Kendrick Extrication Device

Diagram of a Kendrick Extrication Device

The Kendrick Extrication Device (KED) is a device that is used invehicle extricationto remove victims oftrafficcollisionsfrommotor vehicles. Commonly carried onambulances, the KED is typically applied by anemergency medical

technician,paramedic, or anotherfirst responder. Typically used in conjunction with acervical collar, the KED is a semi-

rigidbracethat secures the head,neckandtorsoin an anatomically neutral position. This position reduces the possibility ofadditional injuries to these regions during extrication.

Description

Typically there are two headstraps, three torso straps, and two legs straps which are used to adequately secure the KED to the

victim. Unlike along spine boardorlitter, the KED uses a series of wooden orpolymerbars in anylonjacket, allowing the

responders to immobilize the neck and upperspineand remove the victim from the vehicle or other confined space. Although the KED

can also be used to immobilize infants and children, it is preferable to use specifically designedpediatricimmobilization devices

should be used whenever possible. If the KED is used to immobilize an infant or child, appropriate padding must be used to ensure

complete immobilization in a manner that does not obscure thethoraxandabdomen, thereby preventing continued assessment of

these vital areas.

Application
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The device can be quickly and easily inserted into the seat of a vehicle by a singlerescuer, allows access to theairwayand

conforms to any body size. The KED is typically used only onhemodynamicallystable victims; unstable victims are extricated

using rapid extrication techniques without the prior application of the KED.

Once the KED is slid into position, it is secured to the victim with straps in order to prevent movement. The first strap that is

secured is the middle torso strap. According to the K.E.D. users' manual securing this strap secures the greatest area of the device

and therefore provides the greatest stability while securing the rest of the device. Next the bottom torso strap is secured, however the

top torso strap is not secured until just prior to moving the patient to the long spine board. This is to allow the patient to breathe

easily while the rest of the device is secured. Following the bottom torso strap the leg straps are secured. These may be applied in a

"criss-cross" fashion (according to the KED users' manual this is the most commonly used method), or applied by securing them to

their respective sides. If there is any evidence of a groin injury the "criss-cross" method cannot be used. Following application of

the leg straps the void between the head and device is padded as needed and the head is secured. Finally, just prior to moving the

patient to a long spine board the top strap is secured.

Some schools teach this order by remembering the phrase "My Baby Looks Hot Tonight" or "Money Buys Lots of Hot Toys", where

the beginning of each word stands for Middle torso strap, Bottom torso strap, Leg straps, Head strap and Top torso strap.

The head pad can bring the head too far forward for the side panels to fully immobilize it. Care must be taken to secure the head

properly to maintain neutral immobilization. If the head is too far forward, bring the head back to meet the KED unless crepitus,

pain or resistance is met. If these symptoms are present, immobilize the head in the position found.

It is worth noting that there is debate and controversy surrounding the exact order of applying the torso straps, with some

saying that the order does not matter, as long as the torso is secured before the head. The K.E.D. users' manual is sometimes used in

this justification with the explanation that it states the reason the top strap is last is a function of breathing, and not the process

of immobilization itself.Furthermore they will reference the concept that the critical factor in any immobilization process is that

the head is immobilized last, and the order of immobilization prior to that process does not make a difference in terms of the

immobilization itself.

This view is somewhat supported, and likely promulgated by EMS certification organizations such as the National Registry of

EMTs in the United States. In their assessment of seated spinal immobilization (not written for any one specific device)it is stated

that the torso must be immobilized before the head. Moreover one of the critical criteria that can result in failure of the assessment

is if the head is immobilized before the torso is sufficiently secured. The use of sufficiently is of course subjective, but a strict

interpretation of this may lead one to infer that all the torso straps must be secured before the head.

An exhaustive search of the literature for peer reviewed scientific data regarding the positive or negative effects of application of

the K.E.D. straps in any specific order found no results. It is likely such data does not exist, and that there are valid arguments on

both sides of the issue. However, best practices indicate that the manufacturer's directions should be followed whenever using any

piece of medical equipment. That being said, whenever the EMS professional is in doubt about a medical procedure it is advisable to

contact your local medical director.
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Cervical collar

A side view of a person wearing a C spine collar.

A cervical collar (also neck brace) is anorthopedicmedical deviceused to support a patient's neck and head. It is also used byemergency personnelfor victims of traumatic head or neck injuries, and can be used to treat chronic medical conditions.

Whenever patients have atraumatichead or neck injury, they may have acervical fracture. This makes them at high risk

forspinal cord injury, which could be exacerbated by movement of the patient and could lead toparalysisor death. A common

scenario for this injury would be a patient suspected of havingwhiplashdue to acar accident. In order to prevent further injury,

such patients may have a collar placed by medical professionals untilX-rayscan be taken to determine if acervical spine

fractureexists. The cervical collar only stabilizes the top sevenvertebrae, C1 through C7. (Other immobilizing devices such as

aKendrick Extrication Deviceor abackboardcan be used to stabilize the remainder of the spinal column.

Cervical collars are also used therapeutically to help realign the spinal cord and relieve pain, although they are usually not

worn for long periods of time. Another use of the cervical collar is forstrains,sprainsorwhiplash. If pain is persistent, the collar

might be required to remain attached to help in the healing process. A patient may also need a cervical collar, or may require ahalo

fixation deviceto support the neck duringrecoveryafter surgery such ascervical spinal fusion.

Types of cervical collars
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A soft collar is fairly flexible and is the least limiting but can carry a high risk of further breakage, especially in patients

withosteoporosis. It can be used for minor injuries or after healing has allowed the neck to become more stable.

A range of manufactured rigid collars are also used, usually comprising

(a) a firm plastic bi-valved shell secured withVelcrostraps and

(b) removable padded liners. The most frequently prescribed are theAspen,Malibu,Miami J, and Philadelphia collars. All these can

be used with additional chest and head extension pieces to increase stability.

Cervical collars are incorporated into rigid braces that constrain the head and chest together. Examples include theSterno-

Occipital Mandibular Immobilization Device (SOMI),Lerman Minervaand Yale types. Special patients, such as very young children

or non-cooperative adults, are sometimes still immobilized in medical plaster of paris casts, such as theMinerva cast.

Cervical collar in sport

In high-risk motorsports such asMotocross,go-kart racingandspeed-boat racing, racers often wear a protective collar toavoidwhiplashand other neck injuries.

Designs range from simple foam collars to complex compsite devices.

AMotocrossrider wearing a sports neck brace

Lateral view of a cervical collar
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AP view of a cervical collar

Inflatable splint

[infltbl]

Etymology: L, in, within,flare, to blow; ME, splente

a tubular device that is placed around a patient's extremity and inflated with air to maintain rigidity. Also calledpneumaticsplint.INFLATABLE SPLINTS

Inflatable splints are used to immobilise, or keep still, and protect an injury such as a broken arm or leg.

Inflatable splints come in different shapes and sizes and are stored deflated in a small bag in the ambulance. If a patient has aninjury that needs to be protected, the paramedic can place the splint on the limb and then use a small hand pump to inflate thesplint.

This creates a large air balloon around the limb and offers it some protection from moving or knockin it

Traction splint

A traction splint most commonly refers to asplinting devicethat usesstrapsattaching over the pelvis or hip as an anchor, ametal rod(s) to mimic normal bone stability and limb length, and a mechanical device to applytraction(used to reduce pain,

realign the limb, and minimize vascular and neurological complication) to the limb. A traction splint is commonly used to treat
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complete long bone fractures of the leg,femurortibiaandfibulaarea. Traction splints have been instrumental in the reduction of

morbidity and mortality from traumatic events. The use of traction splints byprehospital careis a near-universal skill and

thereby essential piece ofambulanceequipment.

A dynamic traction splint has also been developed for intra-articular fractures of thephalangesof the hand.Principles

Traction splints are most commonly used for shaftfracturesof thefemur(or upper leg bone) and for fractures of the tibia and

fibula. The femur is the longest bone in the body, themusclessurrounding the bone are also strong, when the bone is broken, the

surrounding muscles oftencontract, pulling the bone ends past each other, causing additional injury and blood loss, pain, muscle,

vascular and nerve damage.

Traction splints are applied only when the fracture is isolated to the femur and there are no other associated traumatic injuries

to the leg or pelvis. Use of a traction splint while other fractures in the leg exist will cause the weaker fracture site to pull apart and

not the targeted femur fracture.

History

The first widely used model of traction splint was introduced byHugh Owen Thomas, a Welshsurgeon, considered by many to be

the father of modernorthopaedicsurgery. Prior to the introduction of the Thomas splint c. 1916, mortality fromfemurfractures

ran as high as 80%. Use of this splint reduced the death rate to less than 8%.

Models

There are two groups of traction splints:

The Thomas half-ring group, which includes the Thomas splint, the modified Thomas splint, the hare traction splint and theDonway traction splint

Non-half-ring group, which includes the Sager splint, the Kendrick Traction Device (KTD), and the CT-6.The basic principle is that one end of the traction splint is positioned against thehip, and pushes upward against

thepelvicbone. A strap around the foot andankleis connected to the other end of the splint, and tightened to counteract the muscle

tension and produce traction. Only then are additional straps added to aid immobilization of the limb.

The Thomas half-ring splints consist of a padded half-circle of steel which is strapped to the hip, hinged to a U-shaped rod that

extends along both sides of the leg. An ankle strap may be fashioned from cloth, and tied or twisted to apply traction force. It was

deviced by H.O. Thomas, initially for immobilization for tuberculosis of the knee. It is now commonly used for the immobilisation

of hip and thigh injuries.

The modified Thomas splint adapted the original Thomas splint to include a traction screw and foot plate and limb support

built into the splint body.
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The hare traction splint is a further adaptation of the Thomas splint. Its length is adjustable viatelescopingrods, and it has

built-in straps to support the hip and leg at several points along its length. It also provides a more comfortable ankle strap and a

smallwinchthat makes it much easier to apply and adjust traction force.

The Sager splint is an innovative splint that has introduced a new concept in the fixation of the consists of a metallic splint

that is placed between the patient's legs. Some models may be placed on the side closest to the injury forbilateralfemur fractures

without pelvic trauma. Straps are then applied, first at the thigh and then at the ankle, to strap the injured leg to the pole and

provide support. The pole is extended to supply the needed traction, and then both legs are wrapped withcravat-like straps.

The KTD (Kendrick Traction Device) eliminates the need for leg-raising and unnecessary rolling of the patient, and can be easily

applied to both pediatric and adult applications. It consists of a round pole that can be located on the lateral aspect of the leg, with

straps at the upper thigh and ankle for immediate placement, and three wider straps for immobilization. It is very light at 20

ounces. The KTD does not afford the rotational stability normally seen in long bone traction splints.

The CT-6 was introduced in the 21st century and utilizes a 4:1 pulley system to achieve precise and powerful, when necessary,traction. This splint is built with Carbon Fiber tubing and weighs in at just 500 grams. In 2003 the CT-6 was chosen as the splint

of choice by the US military and currently has over 30,000 in the field. Its compact and light design, along with its greatly

improved traction method, had greatly enhanced its popularity.

The Donway traction splint is a pneumatic splint that can be applied to a patient insitu. Acting on the ankle and groin

pressure is then applied via an integrated pump. The devices itself consists of a metal frame that surrounds the leg that is then

strapped into place.

Dynamic traction splint

In 1986, Dr. Robert R. Schenck used the same principals applied to treating femur fractures to develop a device for treating

intra-articular fractures of the finger. The apparatus consists of a 6-inch-diameter circular splint that provides a rigid arc, with a

3-inch radius equidistant from the involved joint. A wire is placed horizontally through the distal head of the middle phalanx. The

wire is attached by rubber band to a movable component attached to the hoop of the splint. The amount of traction can be controlled

by using different types ofrubber bandsor tying knots in them.
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Dynamic traction splint

In 1993, a study conducted by Chinchalker and Patterson et al. involving 14 patients concluded "[I]mmediate mobilization of

intra-articular fractures with dynamic traction predictably resulted in a functional joint".

Pulse oximetry

A finger mounted pulse oximeter taking measurement through the fingernail.
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A wrist mounted remote sensor pulse oximeter with plethysmogram.

Pulse oximetry is anon-invasivemethod allowing the monitoring of theoxygenationof a patient'shemoglobin.A sensor is placed on a thin part of the patient's body, usually afingertiporearlobe, or in the case of aninfant, across a foot.

Light of two different wavelengths is passed through the patient to a photodetector. The changing absorbance at each of

thewavelengthsis measured, allowing determination of theabsorbancesdue to the pulsingarterialbloodalone,

excludingvenousblood, skin, bone, muscle, fat, and (in most cases) nail polish. WithNIRSit is possible to measure both

oxygenated and deoxygenated hemoglobin on a peripheral scale (possible on both brain and muscle).

Reflectance pulse oximetry may be used as an alternative to transmissive pulse oximetery described above. This method does not

require a thin section of the patient's body and is therefore well suited to more universal application such as the feet, forehead and

chest.

History

In 1935Karl Matthesdeveloped the first 2-wavelength ear O2 saturation meter with red and green filters, later switched to red

and infrared filters. This was the first device to measure O2 saturation. The original oximeter was made byGlenn Allan Millikanin

the 1940s.

In 1949 Wood added a pressure capsule to squeeze blood out of ear to obtain zero setting in an effort to obtain absolute

O2 saturation value when blood was readmitted. The concept is similar to today's conventional pulse oximetry but was hard to

implement because of unstablephotocellsand light sources. This method is not used clinically.

In 1964 Shaw assembled the first absolute reading ear oximeter by using eight wavelengths of light. Commercialized byHewlett-

Packard, its use was limited to pulmonary functions andsleep laboratoriesdue to cost and size.

Pulse oximetry was developed in 1972, byTakuo Aoyagiand Michio Kishi, bioengineers, atNihon Kohdenusing the ratio of redto infrared light absorption of pulsating components at the measuring site. Susumu Nakajima, a surgeon, and his associates first

tested the device in patients, reporting it in 1975. It was commercialized byBioxin 1981 andNellcorin 1983.

Biox was founded in 1979, and introduced the first pulse oximeter to commercial distribution in 1981. Biox initially focused

on respiratory care, but when the company discovered that their pulse oximeters were being used in operating rooms to monitor
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oxygen levels, Biox expanded its marketing resources to focus on operating rooms in late 1982. A competitor, Nellcor (now part

ofCovidien, Ltd.), began to compete with Biox for the U.S. operating room market in 1983.

Prior to its introduction, a patient's oxygenation could only be determined byarterial blood gas, a single-point measurement

that takes a few minutes of processing by a laboratory. (In the absence of oxygenation,damage to the brainstarts within 5 minutes

withbrain deathensuing within another 1015 minutes). In the U.S. alone, approximately $2 billion was spent annually on this

measurement. With the introduction of pulse oximetry, a non-invasive, continuous measure of patient's oxygenation was possible,

revolutionizing the practice of anesthesia and greatly improving patient safety. Prior to its introduction, studies

inanesthesiajournals estimated U.S. patient mortality as a consequence of undetectedhypoxemiaat 2,000 to 10,000 deaths per

year, with no known estimate of patient morbidity

By 1987, the standard of care for the administration of a general anesthetic in the U.S. included pulse oximetry. From the

operating room, the use of pulse oximetry rapidly spread throughout the hospital, first to therecovery room, and then into the

variousintensive care units. Pulse oximetry was of particular value in the neonatal unit where the patients do not thrive with

inadequate oxygenation, but also can be blinded with too much oxygen. Furthermore, obtaining an arterial blood gas from a

neonatal patient is extremely difficult.

In 1995, Masimo introduced Signal Extraction Technology (SET) that could measure accurately during patient motion and low

perfusion. Some have termed newer generation pulse oximetry technologies high resolution pulse oximetry (HRPO). One area of

particular interest is the use of pulse oximetry in conducting portable and in-homesleep apneascreening and testing.

In 2009, the world's first Bluetooth-enabled fingertip pulse oximeter was introduced byNonin Medical, enabling clinicians to

remotely monitor patients' pulses and oxygen saturation levels. It also allows patients to monitor their own health through online

patient health records and home telemedicine system.

Function

A blood-oxygen monitor displays the percentage of arterialhemoglobinin theoxyhemoglobinconfiguration. Acceptable normal

ranges for patients withoutCOPDwith ahypoxic driveproblem are from 95 to 99 percent, those with a hypoxic drive problem would

expect values to be between 88 to 94 percent, values of 100 percent can indicate carbon monoxide poisoning. For a patient breathing

room air, at not farabove sea level, an estimate of arterial pO2 can be made from the blood-oxygen monitor SpO2 reading.

Pulse oximetry is a particularly convenientnoninvasivemeasurement method. Typically it utilizes a pair of smalllight-

emitting diodes(LEDs) facing aphotodiodethrough a translucent part of the patient's body, usually a fingertip or an earlobe.

One LED is red, withwavelengthof 660 nm, and the other isinfrared, 905, 910, or 940 nm. Absorption at these wavelengths

differs significantly between oxyhemoglobin and its deoxygenated form; therefore, the oxy/deoxyhemoglobin ratio can be calculated

from the ratio of the absorption of the red and infrared light. The absorbance of oxyhemoglobin and deoxyhemoglobin is the same

(isosbestic point) for the wavelengths of 590 and 805 nm; earlier equipment used these wavelengths for correction of hemoglobin

concentration.
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The monitored signal bounces in time with theheart beatbecause the arterialblood vesselsexpand and contract with each

heartbeat. By examining only the varying part of theabsorption spectrum(essentially, subtracting minimum absorption from peak

absorption), a monitor can ignore other tissues or nail polish, (though black nail polish tends to distort readings) and discern

only the absorption caused by arterial blood. Thus, detecting a pulse is essential to the operation of a pulse oximeter and it will not

function if there is none.

Indication

A pulse oximeter (saturometer) is amedical devicethat indirectly monitors the oxygen saturation of a patient'sblood(as

opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing

aphotoplethysmogram. It is often attached to amedical monitorso staff can see a patient's oxygenation at all times. Most

monitors also display the heart rate. Portable, battery-operated pulse oximeters are also available for home blood-oxygen monitoring.

Advantages

A pulse oximeter is useful in any setting where a patient'soxygenationis unstable, includingintensive care, operating,

recovery, emergency and hospital ward settings,pilotsin unpressurized aircraft, for assessment of any patient's oxygenation, and

determining the effectiveness of or need for supplementaloxygen. Assessing a patient's need for oxygen is the most essential element

to life; no human life thrives in the absence of oxygen (cellular or gross).

Although a pulse oximeter is used to monitor oxygenation, it cannot determine the metabolism of oxygen, or the amount of

oxygen being used by a patient. For this purpose, it is necessary to also measurecarbon dioxide(CO2) levels. It is possible that it

can also be used to detect abnormalities in ventilation.

However, the use of a pulse oximeter to detecthypoventilationis impaired with the use of supplemental oxygen, as it is only

when patients breathe room air that abnormalities in respiratory function can be detected reliably with its use. Therefore, the routine

administration of supplemental oxygen may be unwarranted if the patient is able to maintain adequate oxygenation in room air,

since it can result in hypoventilation going undetected]

Because of their simplicity and speed, pulse oximeters are of critical importance inemergency medicineand are also very useful

for patients with respiratory or cardiac problems, especiallyCOPD, or for diagnosis of somesleep disorderssuch

asapneaandhypopnea. Portable battery-operated pulse oximeters are useful for pilots operating in a non-pressurized aircraft above

10,000 feet (12,500 feet in the U.S.) where supplemental oxygen is required. Prior to the oximeter's invention, many

complicatedblood testsneeded to be performed. Portable pulse oximeters are also useful for mountain climbers and athletes whose

oxygen levels may decrease at highaltitudesor with exercise. Some portable pulse oximeters employ software that charts a patient's

blood oxygen and pulse, serving as a reminder to check blood oxygen levels.

Limitations

Pulse oximetry measures solely oxygenation, notventilationand is not a complete measure of respiratory sufficiency. It is not

a substitute forblood gaseschecked in a laboratory, because it gives no indication of base deficit, carbon dioxide levels, bloodpH, or
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bicarbonateHCO3-concentration. The metabolism of oxygen can be readily measured by monitoring expired CO2, but saturation

figures give no information about blood oxygen content. Most of the oxygen in the blood is carried by hemoglobin; in severe anemia,

the blood will carry less total oxygen, despite the hemoglobin being 100% saturated.

Erroneously low readings may be caused byhypoperfusionof the extremity being used for monitoring (often due to a limb being

cold, or fromvasoconstrictionsecondary to the use ofvasopressoragents); incorrect sensor application; highlycallousedskin; or

movement (such as shivering), especially during hypoperfusion. To ensure accuracy, the sensor should return a steady pulse and/or

pulse waveform.

It is also not a complete measure of circulatory sufficiency. If there is insufficientbloodflowor insufficient hemoglobin in the

blood (anemia), tissues can sufferhypoxiadespite highoxygen saturationin the blood that does arrive.

Since pulse oximetry only measures the percentage of bound hemoglobin, a falsely high or falsely low reading will occur when

hemoglobin binds to something other than oxygen:

Hemoglobin has a higher affinity to carbon monoxide than oxygen, and a high reading may occur despite the patient actuallybeing hypoxemic. In cases ofcarbon monoxide poisoning, this inaccuracy may delay the recognition ofhypoxemia(low blood

oxygen level).

Cyanide poisoninggives a high reading, because it reduces oxygen extraction from arterial blood. In this case, the reading isnot false, as arterial blood oxygen is indeed high in early cyanide poisoning.

Methemoglobinemiacharacteristically causes pulse oximetry readings in the mid-80s.The only noninvasive method allowing continuous measurement of the dyshemoglobins is a pulseCO-oximeter, invented in 2005 byMasimo. It provides clinicians a way to measure total hemoglobin levels in addition tocarboxyhemoglobin,methemoglobinand PVI,

which initial clinical studies have shown may provide a new method for automatic, noninvasive assessment of a patient's fluid

volume status. Appropriate fluid levels are vital to reducing postoperative risks and improving patient outcomes: fluid volumes that

are too low (under-hydration) or too high (over-hydration) have been shown to decrease wound healing and increase the risk of

infection or cardiac complications.

Oxygen mask
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A plastic oxygen mask on anERpatient.

An oxygen mask provides a method to transfer breathingoxygengas from a storage tank to thelungs. Oxygen masks may coverthe nose and mouth (oral nasal mask) or the entire face (full-face mask). They may be made ofplastic,silicone, orrubber.

(Note: In certain circumstances, oxygen may be delivered via anasal cannulainstead of a mask; cannulas are described inaseparate article.)

Medical plastic oxygen masks

Medical plastic oxygen masks are used primarily by medical care providers foroxygen therapybecause they are disposable and

so reduce cleaning costs and infection risks. Mask design can determine accuracy of oxygen delivered with many various medical

situations requiring treatment with Oxygen.

Oxygen is naturally occurring in room air at 21% and higher percentages are often essential in medical treatment. Oxygen in

these higher percentages is classified as a drug with too much oxygen being potentially harmful to a patients health resulting inoxygen dependence, over time, and in extreme circumstances patient blindness. For these reasons oxygen therapy is closely

monitored.

Masks are light in weight and attached using an elasticated headband or ear loops, they are transparent allowing the face visible

for patient assessment by healthcare provider and reducing a sensation of claustrophobia experienced by some patients when wearing
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an oxygen mask. The vast majority of patients having an operation will at some stage wear an oxygen mask, they may alternatively

wear nasal cannula but oxygen delivered in this way is less accurate and restricted in concentration.

Silicone and rubber masks

Silicone and rubber oxygen masks are heavier than plastic masks. They are designed to provide a good seal for long-duration usebyaviators, medical research subjects, andhyperbaric chamberand other patients that require administration of pure oxygen, such

ascarbon monoxide poisoninganddecompression sicknessvictims.Valvesinside these tight-fitting masks control the flow of gases

into and out of the masks, so that rebreathing of exhaled gas is minimised.

Hoses and tubing and oxygen regulators

Hoses or tubing connect an oxygen mask to the oxygen supply. Hose is larger in diameter than tubing and can allow greater

oxygen flow. When hose is used it may have a ribbed or corrugated design to allow bending of the hose while preventing twisting andcutting off the oxygen flow. The quantity of oxygen delivered from the storage tank to the oxygen mask is controlled by a valve called

aregulator.

Some types of oxygen masks have a breathing bag made of plastic or rubber attached to the mask or oxygen supply hose to store a

supply of oxygen to allow deep breathing without waste of oxygen with use of simple fixed flow regulators.

Oxygen masks for aviators

AT-37pilot wearing a mask designed for both diluter- and pressure-demand breathing
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Inner view of a military aviators mask showing face seal, facepiece and inhalation valves

Three main kinds of oxygen masks are used bypilotsand crews who fly at high altitudes: continuous flow, diluter demand, and

pressure demand.

In a continuous-flow system, oxygen is provided to the user continuously. It does not matter if the user is exhaling or inhaling

as oxygen is flowing from the time the system is activated. Below the oxygen mask is a rebreather bag that collects oxygen during

exhalation and as a result allows a higher flow rate during the inhalation cycle.

Diluter-demandandpressure-demandmasks supply oxygen only when the user inhales. They each require a good seal between the

mask and the users face.

In adiluter-demand system, as the altitude increases (ambient pressure, and therefore the partial pressure of ambient oxygen,

decreases), the oxygen flow increases such that the partial pressure of oxygen is roughly constant. Diluter-demand oxygen systems

can be used up to 40,000 feet.

In apressure-demand system, oxygen in the mask is above ambient pressure, permitting breathing above 40,000 feet.[3]Because

the pressure inside themask is greater than the pressure around the users torso, inhalation is easy, but exhalation requires more

effort. Aviators are trained in pressure-demand breathing inaltitude chambers. Because they seal tightly, pressure-demand-type

oxygen masks are also used in hyperbaric oxygen chambers and for oxygen breathing research projects with standard oxygen

regulators.

Many designs of aviator's oxygen mask contain a microphone to transmit speech to other crew members and to the aircraft's

radio. Military aviators' oxygen masks have face pieces that partially cover the sides of the face and protect the face against flash

burns, flying particles, and effects of a high speed air stream hitting the face during emergency evacuation from the aircraft

byejection seatorparachute. They are often part ofapressure suitor intended for use with aflight helmet.

An early 1919 high-altitude oxygen system used a vacuum flask of liquid oxygen to supply two people for one hour at 15,000feet. The liquid passed through several warming stages before use, as expansion when it evaporated, and absorbedlatent heat of

vaporization), would make the gasified oxygen so cold that it could cause instantfrostbiteof the lungs.
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Aviation passenger masks and emergency oxygen systems

Emergency oxygen masks deployed

Mostcommercial aircraftare fitted with oxygen masks for use when cabin pressurization fails. n general, commercial aircraft

arepressurizedso that the cabin air is at a pressure equivalent to no more than 8,000 feet altitude (usually somewhat loweraltitude), where one can breathe normally without an oxygen mask.

If the oxygen pressure in the cabin drops below a safe level, riskinghypoxia, compartments containing the oxygen masks will

open automatically, either above or in front of the passenger and crew seats, and in the lavatories.

In the early years of commercial flight, before pressurized cabins were invented, airliner passengers sometimes had to wear oxygen

masks during routine flights.

Self-contained breathing apparatus (SCBA)

Firefightersandemergency serviceworkers use full face masks that provide breathing air as well as eye and face protection. Thesemasks are typically attached to a tank carried upon the back of the wearer and are calledself-contained breathing

apparatuses(SCBA).

Because oxygen breathing is hazardous in areas where fires may be burning, and becauseopen-circuit compressed-air breathing

setsare easier to refill thanrebreathers, SCBA units are normally filled with compressed breathing air rather than oxygen.
http://en.wikipedia.org/wiki/Commercial_aircrafthttp://en.wikipedia.org/wiki/Commercial_aircrafthttp://en.wikipedia.org/wiki/Commercial_aircrafthttp://en.wikipedia.org/wiki/Cabin_pressurizationhttp://en.wikipedia.org/wiki/Cabin_pressurizationhttp://en.wikipedia.org/wiki/Cabin_pressurizationhttp://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Firefighterhttp://en.wikipedia.org/wiki/Firefighterhttp://en.wikipedia.org/wiki/Emergency_servicehttp://en.wikipedia.org/wiki/Emergency_servicehttp://en.wikipedia.org/wiki/Emergency_servicehttp://en.wikipedia.org/wiki/Self-contained_breathing_apparatushttp://en.wikipedia.org/wiki/Self-contained_breathing_apparatushttp://en.wikipedia.org/wiki/Self-contained_breathing_apparatushttp://en.wikipedia.org/wiki/Self-contained_breathing_apparatushttp://en.wikipedia.org/wiki/Open-circuit_scuba#Open_circuit_scuba_setshttp://en.wikipedia.org/wiki/Open-circuit_scuba#Open_circuit_scuba_setshttp://en.wikipedia.org/wiki/Open-circuit_scuba#Open_circuit_scuba_setshttp://en.wikipedia.org/wiki/Open-circuit_scuba#Open_circuit_scuba_setshttp://en.wikipedia.org/wiki/Rebreatherhttp://en.wikipedia.org/wiki/Rebreatherhttp://en.wikipedia.org/wiki/Rebreatherhttp://en.wikipedia.org/wiki/File:Passenger_oxygen_mask_dsc06035.jpghttp://en.wikipedia.org/wiki/File:Passenger_oxygen_mask_dsc06035.jpghttp://en.wikipedia.org/wiki/File:Passenger_oxygen_mask_dsc06035.jpghttp://en.wikipedia.org/wiki/File:Passenger_oxygen_mask_dsc06035.jpghttp://en.wikipedia.org/wiki/Rebreatherhttp://en.wikipedia.org/wiki/Open-circuit_scuba#Open_circuit_scuba_setshttp://en.wikipedia.org/wiki/Open-circuit_scuba#Open_circuit_scuba_setshttp://en.wikipedia.org/wiki/Self-contained_breathing_apparatushttp://en.wikipedia.org/wiki/Self-contained_breathing_apparatushttp://en.wikipedia.org/wiki/Emergency_servicehttp://en.wikipedia.org/wiki/Firefighterhttp://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Cabin_pressurizationhttp://en.wikipedia.org/wiki/Commercial_aircraft


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Specialized masks for divers and astronauts

Specialized full-face masks that supply oxygen or otherbreathing gasesare used bydiversandastronautsto remove nitrogen

from their blood beforespace walks(EVA) or underwater decompression.

Anesthesia oxygen masks

Anesthesia masks are face masks that are designed to administeranestheticgases to a patient through inhalation. Anesthesia

masks are either made of anti-static silicone or rubber, as a static electricity spark may ignite some anesthetic gases. They are either

black rubber or clear silicone. Anesthesia masks fit over the mouth and nose and have a double hose system. One hose carries inhaled

anesthetic gas to the mask and the other brings exhaled anesthetic gas back to the machine. Anesthesia masks have 4 point head strap

harnesses to securely fit on the head to hold the mask in place as the anaethesia doctor controls the gases and oxygen inhaled.

Masks for high-altitude climbers

Oxygen masks are used byclimbersof high peaks such asMt. Everest. Because of the severe cold and harsh conditions oxygenmasks for use at extreme altitude must be robust and effective. The oxygen storage tanks used with the masks, called oxygen bottles

are made of light-weight, high-strength metals and are covered in high-strength fiber such askevlar.

These special oxygen bottles are filled with oxygen at a very high pressure which provides a longer time duration of oxygen for

breathing than standard pressure oxygen bottles. These systems are generally only used above 7000 meters.

The makers of the"Top Out"high-altitude oxygen system claim that "Oxygen is delivered to the mask as a constant flow

adjusted according to need by a regulator. While the climber breaths out the constant flow oxygen is diverted by an internal valve to

an accumulator as in the TopOut oxygen system. When an inhalation is made the accumulated oxygen and the amount of constant

flow is delivered as the first part of the breath, deep into the lungs for best affect onto the alveoli.

The rich oxygen mix is the first part of the breath until the accumulator empties then a secondary valve opens to allow ambient

air to complete the filling of the anatomical dead space, the pipe work feeding the deep lung where no oxygen exchange can take place.

All the oxygen from the cylinder must now process through the lungs without waste and in a preferred order to prolong the

extraction time into the bloodstream."

Oxygen helmets

Oxygen helmets are used inhyperbaric oxygenchambers for oxygen administration. They are transparent light weight plastic

helmets with a seal that goes around the wearer's neck that looks like aspace suithelmet.

They offer a good visual field. Light weight plastic hoses provide oxygen to the helmet and remove exhaled gas to the outside of the

chamber. Oxygen helmets are often preferred for oxygen administration in hyperbaric oxygen chambers for children and patients

that are uncomfortable wearing an oxygen mask.

Mask retention systems
http://en.wikipedia.org/wiki/Breathing_gaseshttp://en.wikipedia.org/wiki/Breathing_gaseshttp://en.wikipedia.org/wiki/Breathing_gaseshttp://en.wikipedia.org/wiki/Underwater_divinghttp://en.wikipedia.org/wiki/Underwater_divinghttp://en.wikipedia.org/wiki/Underwater_divinghttp://en.wikipedia.org/wiki/Astronauthttp://en.wikipedia.org/wiki/Astronauthttp://en.wikipedia.org/wiki/Astronauthttp://en.wikipedia.org/wiki/Space_walkhttp://en.wikipedia.org/wiki/Space_walkhttp://en.wikipedia.org/wiki/Space_walkhttp://en.wikipedia.org/wiki/Anesthetichttp://en.wikipedia.org/wiki/Anesthetichttp://en.wikipedia.org/wiki/Anesthetichttp://en.wikipedia.org/wiki/Climbershttp://en.wikipedia.org/wiki/Climbershttp://en.wikipedia.org/wiki/Climbershttp://en.wikipedia.org/wiki/Mt._Everesthttp://en.wikipedia.org/wiki/Mt._Everesthttp://en.wikipedia.org/wiki/Mt._Everesthttp://en.wikipedia.org/wiki/Kevlarhttp://en.wikipedia.org/wiki/Kevlarhttp://en.wikipedia.org/wiki/Kevlarh

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Emergency Devices

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